Venous thromboembolic diseases:

the management of venous thromboembolic diseases and

the role of thrombophilia testing

Two-level Wells score: templates

for deep vein thrombosis and
pulmonary embolism

June 2012

NICE clinical guideline 144

These two-level DVT (deep vein thrombosis) and PE (pulmonary embolism)
Wells score templates accompany the clinical guideline: ‘Venous
thromboembolic diseases: the management of venous thromboembolic
diseases and the role of thrombophilia testing’ (available at
www.nice.org.uk/guidance/CG144). Issue date: June 2012.

This is a support tool for implementation of NICE guidance.

It is not NICE guidance.

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and/or providers. Commissioners and providers are reminded that it is their
responsibility to implement the guidance, in their local context, in light of their
duties to avoid unlawful discrimination and to have regard to promoting equality
of opportunity. Nothing in the guidance should be interpreted in a way that
would be inconsistent with compliance with those duties.

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NICE clinical guideline 144: Two-level Wells score templates for deep vein thrombosis
and pulmonary embolism 2
Introduction
Clinical probability scores help to stratify people into different risk categories, so
that the most appropriate diagnostics pathway or treatment pathways can be
followed. Wells scores are a clinical prediction rule for estimating the probability
of DVT and PE. There are a number of versions of Wells scores available. The
NICE clinical guideline 144 recommends the use of the two-level DVT and PE
Wells scores to aid diagnosis of PE or DVT (see recommendations 1.1.2 and
1.1.8 in the guideline). This document contains a template two-level DVT and
PE Wells score.

Print the template you require (either page 5 or 6), complete during your patient
assessment and then file in the patients records.

Wells score background

Deep-vein thrombosis
The original 1997 DVT Wells score used a three-level risk stratification system.
The 2003 version (which is referred to in the literature as ‘updated’, ‘modified’,
‘revised’ or ‘two-level’) uses two levels of risk stratification:

Wells score (1997) (original) In 1997, Wells et al.1 developed a nine-

component clinical prediction rule for DVT. Two points are deducted if an
alternative diagnosis to DVT is at least as likely. This gives a possible score
range of −2 to 8. There were three risk categories: high (3 points or more),
intermediate (1–2 points) and low (less than 1 point). This is also sometimes
referred to as the Hamilton score, with a slight change of wording.

Wells score (2003) (two level) In 2003 a further component, previously

documented DVT, was added to the original Wells score. Additionally, the
duration of risk after surgery was increased from 4 weeks to 12 weeks2. This
gives a possible score range of −2 to 9. This version reduced the number of risk
categories from three to two: likely (2 points or more) and unlikely (less than
2 points).

Pulmonary embolism

NICE clinical guideline 144: Two-level Wells score templates for deep vein thrombosis
and pulmonary embolism 3
PE Wells score (1998) (original) In 1998, Wells et al.3 developed a seven-
component clinical prediction rule for PE. Points are given based on criteria in
the history and examination, for example, signs of DVT, tachycardia greater
than 100 beats per minute, active cancer and recent immobilisation. This gives
a possible score range of 0 to 12.5 points. A score of greater than 6 is classified
as ‘high risk’ of PE; a score of 2 to 6 as ‘intermediate risk’ of PE; and a score
less than 2 as ‘low risk’.

PE Wells score (2000) (two level) In 2000 the Wells score for PE was revised
to reduce the number of risk categories to two: likely (more than 4 points) and
unlikely (4 points or less)4.

References
1.Wells PS, Anderson DR, Bormanis J et al. (1997). Value of assessment of
pretest probability of 6 deep-vein thrombosis in clinical management. Lancet
350: 1795–8

2. Wells PS, Anderson DR, Rodger M et al. (2003). Evaluation of D-dimer in the
diagnosis of 8 suspected deep-vein thrombosis. New England Journal of
Medicine 349: 1227–35.

3. Wells PS, Ginsberg JS, Anderson DR et al (1998) Use of a clinical model for
safe management of patients with suspected pulmonary embolism. Annals of
Internal Medicine 129: 997–1005.

4. Wells PS, Anderson DR, Rodger M et al. (2001) Excluding pulmonary

embolism at the bedside without diagnostic imaging: management of patients
with suspected pulmonary embolism presenting to the emergency department
by using a simple clinical model and d-dimer. Annals of Internal Medicine. 135:
98–107.

NICE clinical guideline 144: Two-level Wells score templates for deep vein thrombosis
and pulmonary embolism 4
Insert your organisation’s
logo

Suspected deep vein thrombosis

Patient name.........................................................................................................

Patient hospital number.........................................................................................

Date of assessment...............................................................................................

Assessor’s name (print)..............................................Signed................................

Two-level DVT Wells score

Clinical feature Points Patient score

Active cancer (treatment ongoing, within 6 months, or

1
palliative)
Paralysis, paresis or recent plaster immobilisation of the
1
lower extremities
Recently bedridden for 3 days or more or major surgery
1
within 12 weeks requiring general or regional anaesthesia
Localised tenderness along the distribution of the deep
1
venous system

Entire leg swollen 1

Calf swelling at least 3 cm larger than asymptomatic side 1

Pitting oedema confined to the symptomatic leg 1

Collateral superficial veins (non-varicose) 1

Previously documented DVT 1

An alternative diagnosis is at least as likely as DVT −2

Clinical probability simplified score

DVT likely 2 points or more

DVT unlikely 1 point or less

Adapted with permission from:

Template Two-level DVT Wells score

From NICE clinical guideline 144 VTE diseases (June 2012)
 - Wells PS et al. (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein
thrombosis. New England Journal of Medicine 349: 1227–35
- The National Clinical Guideline Centre

Template Two-level DVT Wells score

From NICE clinical guideline 144 VTE diseases (June 2012)
Insert your organisation’s
logo

Suspected pulmonary embolism

Patient name.........................................................................................................

Patient hospital number........................................................................................

Date of assessment..............................................................................................

Assessor’s name (print).............................................. Signed..............................

Two-level PE Wells score

Clinical feature Points Patient score

Clinical signs and symptoms of DVT (minimum of leg

3
swelling and pain with palpation of the deep veins)

An alternative diagnosis is less likely than PE 3

Heart rate > 100 beats per minute 1.5

Immobilisation for more than 3 days or surgery in the

1.5
previous 4 weeks

Previous DVT/PE 1.5

Haemoptysis 1

Malignancy (on treatment, treated in the last 6 months, or

1
palliative)

Clinical probability simplified scores

More than
PE likely
4 points

PE unlikely 4 points or less

Adapted with permission from

- Wells PS et al. (2000) Derivation of a simple clinical model to categorize patients’ probability
of pulmonary embolism: increasing the model’s utility with the SimpliRED D-dimer.
Thrombosis and Haemostasis 83: 416–20
- The National Clinical Guideline Centre

Template Two-level PE Wells score

From NICE clinical guideline 144 VTE diseases (June 2012)